LA County Department of Public Health - CONFERENCE REGISTRATION FORM

Participants will learn about the "cycle of violence," steps for screening a patient involved in IPV, review mandatory domestic violence reporting laws, and understand the clinic's legal responsibilities. The class also reviews brain development of exposure to chronic violence, how to document domestic violence on the patient's care plan, and resources available for patients in domestic violence relationships.

LOCATION: Superior Court Building
600 S. Commonwealth Ave
8th Floor, Conference Room B
Los Angeles, CA 90005

Prerequisite: None
Intended Audience: All staff providing direct patient care and program oversight (including mid-level practitioners, supervisors and managers)

Registration: 12:00-12:30
Training Begins Promptly at 12:30.
If participants arrive 15 minutes late, certificates of attendance may not be given.
CONTACT: Paula Binner At (213-639-6424) Or pbinner@ph.lacounty.gov

Participant Information
* First name:
* Last name:
* Position Title:
* Work Organization:
* Street1:
Street2:
* City:	State: Zip:

* Phone:	Fax: (e.g.999-999-9999)
* Email:
* Immediate Supervisor's Name:

* Please select 1 next to the class that you would like to attend
2014 Intimate Partner Violence: Monday, May 19th 12:00 PM - 4:30 PM

* I have received my supervisor's approval to attend the marked session(s):
* I am available to attend any of the sessions I have marked above.